Moroccan Medical Madness

Yesterday marked my first medical experience in Morocco, and it was both hilarious and unnerving at the same time. In order to get my residency permit in Morocco, I had to pass a medical exam by a doctor who is certified to perform such examinations. Michael's colleague from France, Marie, and Chris, the wife of the other American family with whom we moved here, also needed to have this exam performed, so we decided to all go together for moral support. It's a good thing we did because the whole experience would have been downright terrifying if we hadn't!

Let me preface this tale by reassuring you that the medical facilities our family will be going to for routine care will be FAR different and much more on par with US medical facilities than what we experienced for this exam.  If we happen to have a life-threatening or serious medical condition develop, our medical insurance here pays for us to be evacuated to Europe or the US.

So...let's start at the beginning. Our driver, Younes, dropped us off a little early at the appointment, so we decided to pass the time with a coffee break at a nearby cafe.  Most Moroccan cafes are dominated by men, so the scene looked something like this:

We ventured into one of these typical, male-dominated cafes and were pleased we didn't draw too many stares.  I had a cup of café allongé (the closest to American coffee I've found here).  Afterwards, we sauntered over to the doctor's office, which was labeled with a teeny sign about the size of my hand that was barely noticeable from the street. Our husbands had been to the same office about two weeks earlier and drove back and forth multiple times before finding it. We were amazed that our driver had found it on the first try!

Anyway, we walked up a flight of stairs to a little entryway, where a man with two thumbs on one of his hands was standing at a small desk. He motioned for us to sit in the waiting area, just beyond the foyer. We sat. And sat. Waiting is part of the Moroccan experience. I've learned that by now! We chatted for a quite a while, getting to know one another better.  I noticed the time.  It had been 45 minutes already.  I noticed an array of magazines haphazardly strewn on the coffee table, including several issues of the Moroccan medical journal of nephrology (I would have never guessed such a journal existed!) among other things, all written in French.  I noticed the unusual decor - bright purple trim and matching painted light fixtures paired with almost fluorescent green vinyl couches that looked like they had been there since the '70s.  After about an hour, a man whom we assumed was the doctor, came running into the office, huffing and puffing.  He was clearly flustered, was out of breath, and had sweat dripping from his brow.  Within a few minutes, he waved us into the examining room.  All three of us, together in the same room.  HIPAA laws don't apply here!  :-)

We were led into an examination room.  It became evident that sanitation was not a priority.  All kinds of medicine bottles, tongue depressors, cotton swabs, plastic models of the human heart, drug advertisement brochures, and you name it was piled upon a table in the room.  

On closer examination, I saw some sort of a used cotton swab lying on top of the pile, covered with some sort of yellowish substance.  I glanced over at the examining table and saw some ancient-looking electrical medical equipment.  I had no idea what it its purpose was.

After a quick introduction, in French, he angrily asked where we had been for our appointment on Monday.  Fortunately we had a native French speaker along with us, Marie, and she was a huge help to us with translating back and forth during our visit.  Marie seemed confused, as did we, about what he was talking about.  There had been no appointment scheduled on Monday.  Perhaps he was trying to use this as an excuse for his late arrival?  Not sure.

Next he told us he studied medicine in Germany.  He proudly showed us a faded picture of himself as a much younger man, standing with a group of about 10 people that was framed and hung on the wall of the exam room.  He went on to tell us about some of his fellow interns in the picture, something about a woman from Russia, a man from India, and then he found out that Marie also speaks German.  His face immediately lit up.  From that point on, he used a mix of German and French to converse, clearly excited to have someone with whom he could practice his rusty German.

Then the exams began.  Chris was the first one to go.  She hopped up on the table, which looked like this:

The doctor began to ask her a series of random questions, such as:  Where is your family from?  Do you or anyone in your family have diabetes?  How many children do you have?  Are you still having your period?  He then checked her blood pressure and knee reflexes.

Marie and I were standing on the side of the room, clearly uncomfortable with the lack of privacy.  Then I heard the doctor undoing Chris' belt buckle of her pants, and I almost lost it.  What in the world is he doing?  I couldn't help buy wonder.  Shocked by the lack of privacy and what might happen next, I almost burst out laughing from how ridiculous the situation was from my frame of reference as an American.  I looked over at Marie, and she turned away and faced the wall, covering her mouth.  I bit my tongue and looked away, not wanting to see what might happen next.  It turned out he was only palpitating Chris' abdomen.  As Chris later said, maybe he wanted to see if my ovaries were still there?!

Next it was Marie's turn.  He again took her blood pressure and checked her reflexes.  He felt her pulse.  He commented on how slow her heart rate and low her blood pressure was.  He told her he would need to have her take a blood test.  Remember, this was a medical exam to see if we should be granted residency in Morocco.  What in the world does blood pressure and heart rate have to do with that?  Besides, having a low heart rate and blood pressure is generally thought to be a good thing.  Marie is very athletic.

My turn.  I looked over at my two comrades and gave a deep sigh.  He did very little checking on me - just my blood pressure, heart rate, and reflexes.  He asked if I had diabetes in my family. Did I play sports?  Do I have children?  Where is my family from?  When I mentioned my grandfather had immigrated from Germany to the US, he again lit up.

"Where in Germany?" he asked.  "Hamburg," I answered.  "Most Americans come from Düsseldorf," he said.  Hmmmm...I thought.  That's news to me!  :-)

After our exams, he showed us into his office in the next room.  We sat by his desk and were amazed by the mess.  Papers, drug samples, plastic anatomical models, old medical textbooks, advertisements from drug companies, and much more all lay in a mess across his desk, bookshelves, and tables.  I wondered what would be next.

I had a strong desire to go to the restroom to pee, but I was holding it after Mike told me that he had to do a urine test to check for drugs.  I didn't want to empty my bladder prematurely!

The doctor came into the office and sat behind his desk.  He took out a pad of paper and asked for our passports.  He began scribbling a message on the pad, copying our names down.  Good, I thought.  Looks like this is almost over!  I really have to pee!

The doctor talked to Marie.  "I have to get a blood test because of my heart rate and blood pressure," she informed us.  More talking.  "Oh, and my Vitamin D level.  He thinks it's low," she said.

Then he picked up the phone and called someone, talking in a mix of Arabic and French.  Later we found out more.  "It looks like we all three have to get a blood test," she informed us.  "Apparently he thinks we all need to have our vitamin D levels checked."

What?!  I thought.  We all looked at each other in disbelief.  You've got to be kidding me!  What in the world does this have to do with getting a residency permit?  Not wanting to create waves and further slow down this lengthy process, I went along with it.

I asked Marie if we were going to have to do a urine test.  She asked the doctor.  Apparently not.  I excused myself to the restroom, and this is what I saw:

I used a Kleenex as a barrier between my hand and everything I touched.  Unbelievable that this is inside a medical facility!

When I went back to the office, a woman in a lab coat had entered the room.  She must be the phlebotomist, I thought.  She led each of us, separately this time, back into the examination room.  She had trouble getting the needle into Marie's vein, squirting blood all over the place.  Yuck.  After a few minutes of clean up, it was my turn.  I was surprised to see the technician had everything in a medical kit.  I was unable to determine whether everything was sterile, but I thought that surely Chris and Marie would have already complained if it wasn't.  I look away at the smell of alcohol to sanitize my skin.  I felt the prick of the needle and a wave of nausea came over me.  I'm usually pretty tough with blood draws, but the lack of cleanliness of the facility and the strong emotions of the experience made my stomach turn.  Was I going to throw up?  No, but I definitely felt queasy and light headed.

I carefully returned to the office room and sat down.  The doctor wrote more on some papers.  200 dirhams each for today's office visit.  We paid.  Could we have a receipt?  More writing.  It will be another 1200 dirhams for Marie's blood test (more involved) and another 600 for Chris and me.  We told him we would have to pay later.  He agreed.

Glad to have this ordeal behind us, we left he office, walking by the waiting room as we left.  I saw patients waiting.  I couldn't help but wonder what their ailments were and feel worried about their well being in such a facility.  This is commonly the case for developing countries, I know.  Having experienced it myself, I felt a wave of gratitude for the medical care I am privileged to enjoy.

We promptly walked out of the building, and I felt the collective sigh of all three of us.  The relief was palpable.  That's one experience I was very glad to have behind me!

The Ebb and Flow

As the ocean tides ebb and flow, I'm finding, so do the moods in expat life.  Having lived abroad before, I'm familiar with the feeling.  The highs and lows and in-betweens.  The surges.  The wane.  Now that I'm starting to settle into expat life, I see this movement, the continual rhythm of change, as a constant in my new life.

While I haven't hit anything worthy of tidal wave status yet, I've felt the swell of frustration and discouragement on a few occasions recently.  I'll focus this post on one of those occasions:  my first personal experience with the Moroccan postal system.  Let me begin by saying the post office's bad rep preceded my move here.  Expats I met during my initial visit warned me not to trust the mail system here - many packages that are sent here are never received.  Those that are received are opened by postal workers doing customs inspections, and they often levy heavy import taxes before you can take goods home.  For this reason, most foreigners avoid the mail unless it is necessary.

Despite these warnings, I ventured into the local post office today.  Having promised some family and close friends post cards, I have been determined to get some in the mail.  Postcards in hand, I ask our driver to take me to the closest post office.  This happens to be in Dar Bouazza, the little sleepy seaside town close to our home.  

When the driver initially pulls up to the building, I am surprised to see it is inside of a bank.  The driver who is helping us while we get accustomed to the Moroccan way of driving, Younes, accompanies me into the building.  Again to my astonishment, I see throngs of people waiting around on benches.  What are they waiting for?  Stamps?  Packages?  Some bank-related business?  Younes walks in and immediately engages a man who looks like a security guard.  After quite a bit of discussion, the guard gives me a paper to fill out, all in French.   With no English speakers around and spotty French, I have a form to fill out ENTIRELY in French!  Yikes!  Thank goodness for Younes!  The security guard says something else to Younes.  Now it appears that EACH postcard I plan to send needs a form.  What?!  I panic for a moment as I realize I have 30 postcards!  Wait a moment, the guard seems to say, these are going to the US?  Oh.  Then you're at the wrong post office.  What?!  Different post offices for different types of mail service.  Hmmmm...a novel concept!  Deep breath.  But I am relieved to be saved from filling out those 30 different forms and waiting for an eternity in line with kids in tow.  Whew!!

Next stop:  The big post office in Casablanca.  As we drive up to the front of it, I see the typical beggars hovering around, wherever lots of people frequent.  My kids see a young woman, sitting on the sidewalk, showing her scraggly Guinea pig.  The kids insist on stopping to pet it.  Younes pays the woman a dirham for her efforts.  I think about taking a picture, but then decide flashing my iPhone in a place with a lot of beggars maybe isn't the greatest idea.  So no picture.

Again, this post office is located inside some sort of a bank building that also exchanges money for foreign currencies.  Not surprisingly, the big post office has even more throngs of people, sitting around and waiting.  Just waiting.  This time, there appears to be a sign of efficiency, though.  There is a computer screen at the entrance that assigns you a number, presumably your place in line, and prints out a ticket for me. #315. I start to feel more hopeful that perhaps this won't be such a complicated process, after all.  

Another surprise.  My driver, Younes, walks right up to the counter!  I look up at the number on the display.  #183.  Is the number counter display not working or are there really 130 or so people in front of me?  Are we "ditching" people who are waiting to use the post office?  Or are these people here for bank business?  I look around at the throngs of people for their reaction.  I get some "hairy eyeballs."  Is that because I might have ditched them in line?   Or is it because I am a Western woman who appears to be with a Moroccan man, something that is frowned upon by the more conservative Moroccans?

I become very self-conscious and try to surmise what Younes' discussion with the postal/bank worker is about.  The postal workers does lots of typing on some sort of computer.  The man who appears to be the boss figure of the operation walks over and mumbles something in Arabic to the worker waiting on us.  We wait.  More typing on the computer.  At this point, the kids are starting to bug each other, unable to keep their hands off each other.  They start whining about how hot it is and how tired they are.  Nowhere to sit.  All of the seats are taken by the throngs.  I look over at some well behaved Moroccan children and again, I feel self-conscious.  After more back-and-forth discussion and looking at my postcards, Younes writes the cost of mailing the postcards on a scrap of paper. 435 dirhams.  I pull out my bank card. The postal worker shakes his head, indicating that I had to pay with cash.  What?!  I don't carry that kind of cash around!  Oh no.  Really?!  I shake my head and say in French, "non argent, pas d'argent."  No money.  "Je reviens en lundi."  I will return on Monday.  Once again.  Ugh.  And so my feelings ebb.  The water rises.

Then on my way home from the post office, I feel stomach cramps.  I think maybe it's just breakfast not sitting too well.  What did I eat?  Just cereal and milk.  Hmmmm...last night?  Gelato at a little place near the movie theatre.  Ice....made from water...that maybe wasn't filtered.  Uh oh.  I get home and the stomach cramps are worse.  After a long visit to the bathroom, which thankfully wasn't needed while I was in the post office, I start to feel better.  Today becomes a rest day.  My body is thanking me for that.  The tide begins to reverse.

While I lounge around, I work on filling out the kids' school forms and see that I need to put down emergency contact information.  Who to put?  Thankfully we have one other American family from Mike's company who came here at the same time as us.  After a conversation,we agree to be each other's emergency contacts.  Whew.  I feel thankful for our new friends!

Kabira, our housekeeper, makes crepes as a treat this afternoon.  The tide flows out more.  I hear the children splashing and playing in the pool.  A little more rushes.  A neighborhood rooster crows.  I sit down to write and vent.  Despite its confusion at times, life is good.  I'm back onto an even keel for the moment.

The Heart of Morocco

As I sit down to write my first blog entry, I feel a gentle, balmy breeze that waves the palm fronds outside my window.  I hear the playful greeting of an unknown bird and smell the fragrant spices of tagine, cooking in my kitchen.  Since moving to Morocco two weeks ago with my family, it feels as though my senses have been activated, reminding me of former travel experiences while creating something altogether new.  My aim in writing this blog is to capture the Morocco I experience and share it with all of you.

Morocco is new.  It is also old.  It is a place of contrasts.  Young people text on their smartphones as they walk through the Morocco Mall, shopping for skinny jeans.  Old men, dressed in jelabas (traditional Moroccan robes) and fezzes (traditional hats), stand on the street corner, talking about the latest news.  A business man, driving his brand new Mercedes sedan, whizzes by a man driving a donkey cart, carrying vegetables to sell in the city.  A fully covered woman in a burka sits with her toddler at the IKEA play area.  Next to a her, a Moroccan woman in Western dress comforts her own child while wearing no head covering at all.  Juxtapositions.  Contrasts.  

Despite all of these contrasts, Morocco is a place of unity.  People are warm and generous with one another, regardless of their differences.  They are also warm and generous with outsiders.  In fact, during my three weeks of total time in Morocco, I have only been treated with warmth and generosity.  In a country with such dichotomies, it amazes me that there isn't more conflict.  Why aren't the poor more disgruntled about their position?  Why aren't the more old-fashioned people disgusted with all of the change and progress?  Why aren't the conservative Muslims more frustrated with the more liberal ones?

I don't have the answers to these questions.  However, I have read that one of the pillars of Islam  talks about charity - giving to the less fortunate.  This does not only include material wealth, but also giving of one's time and energy, as well as resources.  They believe that God has given them the blessings they have and that they are morally obligated to share what they have with others.  I have seen wealthy Moroccans give freely to the beggars on the street, but also I've also personally witnessed gracious hospitality and kindness from strangers, regardless of their social position.  People have gone out of their way to tell me that I am welcome here.  A man selling flowers gave me a free bouquet for "International Women's Day."  While we were at the market, I saw vendors happily give each of my children a piece of fruit as a gift.  When my son spilled his drink at a restaurant, the waiter immediately brought him a new drink and cleaned up the mess with a smile, insisting it was no problem at all.  

This warmth and kindness to me - a stranger - has touched me so deeply.  What I leave with you today is an image of the big heart of Morocco - a big heart for the whole world.